Arthritis: Management and treatment options

If you're a baby boomer or beyond, experiencing aching joints and temporary stiffness when you get out of bed in the mornings, you're likely experiencing symptoms of arthritis. The word arthritis means "joint inflammation" (arth = joint; itis = inflammation). There are several types of arthritis with the most common ones being rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis, an autoimmune condition, is two to three times more common in women than in men. It's estimated that at least 1.5 million people in the U.S. suffer from rheumatoid arthritis. This chronic condition is usually treated by a patient's primary care physician and/or a rheumatologist and typically involves a regimen of oral medication, perhaps coupled with physical and/or occupational therapy.

By far the most common type of arthritis - and the focus of this article - is osteoarthritis. This condition affects at least 27 million Americans and more than one-third of individuals over the age of 65 have some degree of osteoarthritis. It is equally prevalent among men and women. "We most often see symptoms of osteoarthritis develop in patients over age 50," said Cortez orthopedic surgeon Doug Bagge, MD. "Typically they report pain in the joints and stiffness that takes several minutes to work itself out."

"The main cause of osteoarthritis is simply getting older," said Bagge. "Certain occupations and physical activities that are hard on the joints may make it more likely, but that's not the case for everyone." Having had an injury to or infection in a joint may result in osteoarthritis. There is a hereditary component to osteoarthritis, but it's not strictly hereditary, according to Bagge. In other words, if you have a parent with arthritis you may escape developing it yourself, and if a parent doesn't have the condition, you may still develop it.

"Osteoarthritis is diagnosed based primarily on a patient's history and physical examination," said Bagge. "Plain x-rays are sometimes used to confirm a diagnosis, but expensive imaging such as CT and MRI are not needed." A thorough examination can usually reveal where pain is originating from and it's important for both patient and doctor to know exactly which joints are being affected. "Pain can sometimes 'refer' from the hip to the knee or vice-versa, for example," said Bagge.

The joints most commonly affected with osteoarthritis are the knees, hips, shoulders, and back. Smaller joints such as those in the hands, wrists, elbows, and ankles can also be involved. Mild to moderate osteoarthritis can usually be treated at home with over-the-counter medications. "Tylenol is the first choice over-the counter medication that patients may try. If that is ineffective, then anti-inflammatories such as Aleve, Motrin, and Advil or their generic equivalents give most patients relief from their symptoms," said Bagge. Always consult with your doctor about taking any medications, especially those you take on a regular basis.

"Light exercise is also helpful because it helps people maintain range of motion and keeps the muscles around the joints stronger." Losing weight to put less strain on joints - especially hips and knees - can also help relieve the symptoms of arthritis.

If osteoarthritis progresses, symptoms become more severe. "Patients will begin to have pain even while they're resting, the affected joints may swell, and they'll have decreased range of motion," said Bagge. These symptoms can make everyday activities like getting in and out of the car and putting on socks and shoes challenging.

Osteoarthritis may be aggravated by high-impact exercise such as running and some people find that their symptoms worsen when the weather is changing. "There is no rational explanation for that, but patients report being able to predict a storm moving in based on their symptoms all the time, so there must be something to it," said Bagge.

There is no scientific evidence that supplements such as glucosamine and chondroitin are effective in alleviating the symptoms of osteoarthritis, but according to Bagge, quite a few patients anecdotally report feeling better when taking these compounds. "I'm not opposed to patients taking supplements, but I'm not an advocate either. There's no proof that they're effective, but they have minimal side-effects," said Bagge.

If symptoms of osteoarthritis progress to the point that over-the-counter medications and regular, moderate exercise are not effective, physical therapy is the next step in the treatment plan. "Certain types of physical therapy can help strengthen joints and muscles and reduce pain," said Bagge.

Joint injections may be recommended if non-invasive treatments do not relieve symptoms and a patient's daily activities are being negatively impacted. "Cortisone is commonly used, as is visco-supplementation which is a joint lubricating fluid," said Bagge.

For patients who have severe osteoarthritis that does not respond to the treatments mentioned above, joint replacement may be an option. "This is the solution when non-operative intervention fails to adequately relieve symptoms," says Bagge. Knee and hip replacement operations have become less risky and quite common in recent years, with more than 400,000 such procedures being performed each year in the U.S. Patients are typically hospitalized for one to three days and then recover at home while engaging in a rigorous course of physical therapy. "Patients who are committed to feeling better and complete a course of physical therapy following surgery tend to do very well," says Bagge. "Their quality of life improves dramatically, and I always enjoy hearing stories about what they're up to and doing following their operations. It's like they have a new lease on life."

Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colorado. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal healthcare provider.

Comments » Read and share your thoughts on this story